Chapter 27 PrepU

A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF (40°C) in spite of treatment with antibiotics. Her pulse was high, her blood pressure was low, and her skin was hot, dry, and flushed. The nurse knows that this client most likely is experiencing which type of shock? a. Neurogenic b. Septic c. Anaphylactic d. Cardiogenic

Septic

A 17-year-old athlete died suddenly during a track meet and it was subsequently determined that he had heart disease. Which condition was the most likely cause of his heart failure? a. Atrial regurgitation b. Mitral valve prolapse c. Hypertrophic cardiomyopathy d. Dilated cardiomyopathy

Hypertrophic cardiomyopathy

The nurse must achieve which clinical objectives for a client in cardiogenic shock? Select all that apply. a. Increase coronary perfusion b. Correct pulmonary edema c. Increase cardiac workload and oxygen use d. Improve cardiac output e. Regulate blood volume

-Increase coronary perfusion -Correct pulmonary edema -Improve cardiac output -Regulate blood volume

The nurse is teaching a client with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis. Which statement by the client shows that the client understands this condition? a. "I should report episodes of dizziness or fainting." b. "I should begin an aerobic exercise program." c. "I should take my verapamil at the same time every day." d. "I should limit my daily alcohol ingestion to two drinks."

"I should report episodes of dizziness or fainting."

In a client with hypovolemic shock, which assessment findings alert the nurse that compensatory mechanisms are attempting to support cardiac output. Select all that apply. a. Decreased endothelin release b. Increased heart rate c. Vasoconstriction d. Decreased sodium and water retention e. Activation of the renin-angiotensin-aldosterone system (RAAS)

-Increased heart rate -Vasoconstriction -Activation of the renin-angiotensin-aldosterone system (RAAS)

A child's history of a recurrent sore throat followed by severe knee and ankle pain has resulted in a diagnostic workup and a diagnosis of rheumatic fever. What are the treatment priorities for this child? a. Cardiac catheterization and corticosteroid therapy b. Implanted pacemaker and beta-adrenergic blockers (beta-blockers) c. Antibiotics and anti-inflammatory drugs d. Pain control and oxygen therapy

Antibiotics and anti-inflammatory drugs

What should the nurse teach the pregnant woman about congenital heart defects? a. Congenital heart defects occur during conception. b. Congenital heart defects occur between the 3rd and 8th weeks of development before you know you are pregnant. c. Congenital heart defects cannot be prevented. d. Congenial heart defects occur prior to conception as a result of exposure to toxins.

Congenital heart defects occur between the 3rd and 8th weeks of development before you know you are pregnant.

A client who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which manifestation alerts the nurse to a developing complication? a. Decreased level of consciousness b. Hypoglycemia c. Symmetrical joint pain d. Diarrhea

Decreased level of consciousness

The nurse knows that persons with atrial fibrillation are at risk of developing which cardiac complication? a. Cardiogenic shock b. Systolic dysfunction c. Hypovolemic shock d. Diastolic dysfunction

Diastolic dysfunction

Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which disorder was the player's most likely cause of death? a. Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) b. Hypertrophic cardiomyopathy (HCM) c. Takotsubo cardiomyopathy d. Dilated cardiomyopathy (DCM)

Hypertrophic cardiomyopathy (HCM)

A client has just been told that he has an infection of the inner surface of the heart. He is also told that the bacteria has invaded his heart valves. What term is used for this disease process? a. Cardiomyopathy b. Myocardial infarction c. Pericarditis d. Infective endocarditis

Infective endocarditis

A client with a long history of stable angina suddenly experiences substernal pain that radiates to the left arm, neck, and jaw. He describes the pain as severe and feels as if he is suffocating. He has taken nitroglycerin and not experienced any relief. The client is most likely experiencing: a. respiratory distress syndrome (ARDS) b. Pneumonia c. Gastroesophageal reflux disease (GERD) d. Onset of STEMI

Onset of STEMI

A client comes to the emergency room exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that he has 250 mL of fluid in the pericardial cavity. Which disease should the nurse suspect this client is suffering? a. Pericardial effusion b. COPD c. Myocardial infarction d. Pericarditis

Pericardial effusion

A client is seen in the emergency room reporting sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have? a. Pericarditis b. Pneumonia c. Myocardial infarction d. Abdominal aortic aneurysm

Pericarditis

A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be: a. Prompt diagnosis and treatment of streptococcal infections b. Avoiding frequent dental examinations c. Yearly electrocardiography after the age of 50 d. Annual blood specimen assessed for rheumatoid factor

Prompt diagnosis and treatment of streptococcal infections

The nurse should anticipate administering intravenous antibiotic therapy as a priority to a client experiencing which type of shock? a. Hypovolemic shock b. Cardiogenic shock c. Septic shock d. Anaphylactic shock

Septic shock

A neonate is born with a congenital heart defect. The nurse realizes this defect most likely originated during which week of development? a. The third week of development b. The second week of development c. The first week of development d. The 10th week of development

The third week of development

A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be: a. The valve opens backward, permitting blood to flow from the right ventricle into the right atrium. b. The valve opening permits backward flow to occur when the valve should be closed. c. The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta. d. The valve opening is incompetent, thereby allowing blood to flow back from the pulmonary artery and into the left atrium.

The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.

A client with a suspected MI is brought to the emergency department by ambulance. The nurse caring for this client would expect to receive an order for which laboratory test to confirm a diagnosis of MI? a. Creatine kinase marker b. Complete blood components c. Troponin level d. Calcium level

Troponin level

An older adult client asks the nurse why so many older people develop heart failure. The best response would be increased: a. Myocardial metabolism b. Vascular stiffness c. Response to beta-adrenergic stimulation d. Cardiac tone and compliance

Vascular stiffness

Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins? a. Diuretic b. Natriuretic c. Vasodilation d. Vasoconstriction

Vasoconstriction

A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Which type of reaction is most likely occurring with this client? a. anaphylactic shock b. septic shock c. cardiogenic shock d. neurogenic shock

anaphylactic shock

An older adult client has been diagnosed with chronic heart failure. He is prescribed an ACE inhibitor to treat the symptoms and improve his quality of life. This drug will alleviate the client's symptoms of heart failure by: a. promoting cardiac output through a reduction in afterload. b. blocking the conversion of angiotensin I to angiotensin II. c. enhancing inotropy by maximizing calcium channel function. d. selectively blocking the synthesis of renin in the kidneys.

blocking the conversion of angiotensin I to angiotensin II.

A nurse is teaching a client with newly diagnosed dilated cardiomyopathy (DCM) about associated treatments. The nurse determines that the knowledge is understood when the client correctly matches which drug category to the primary action of decreasing preload by suppressing renal reabsorption of sodium and increasing salt and water excretion? a. diuretics b. beta-blockers c. angiotensin-converting enzyme (ACE) inhibitors d. calcium channel blockers

diuretics

Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______ and ______ the heart. a. contracts; friction rubs b. fills rapidly; compresses c. ruptures; releases d. thickens; stretches

fills rapidly; compresses

A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the BP is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of: a. renal failure due to an overdose of medication. b. pulmonary embolism due to development of deep vein thrombosis. c. hypovolemic shock due to acute intravascular volume loss. d. side effects from the administration of midazolam, causing excessive vasoconstriction.

hypovolemic shock due to acute intravascular volume loss.

The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be: a. aplacing a stent for fluid drainage from the heart. b. improving quality of life by relieving symptoms. c. eliminating CHF through curing the disease. d. maintaining higher oxygen levels to decrease the work of breathing.

improving quality of life by relieving symptoms.

A client reports severe indigestion that has been intermittent; however, the pain is now constant and feels like a vise. The nurse does an ECG and recognizes that the situation is possibly emergent due to ST-segment elevation, which could indicate: a. myocardial infarction. b. advanced hypokalemia. c. benign late repolarization. d. decreased intracranial pressure.

myocardial infarction.